Please print, complete and mail this form to NAPUS NATIONAL OFFICE (Listed Below) FORM 1187-R
PLEASE PRINT, COMPLETE AND MAIL TO NATIONAL OFFICE (listed below)
 
DEADLINE OCTOBER 31st
REQUEST FOR AUTHORIZATION FOR VOLUNTARY ALLOTMENT
OF COMPENSATION FOR PAYMENT OF ORGANIZATION DUES
SOCIAL SECURITY NUMBER   CSA/CSF   CIVIL SERVICE ANNUITY NUMBER
                                                     
 NAME OF RETIRED EMPLOYEE  (LAST/FIRST/MIDDLE)


 
 HOME ADDRESS      STREET AND NUMBER                         CITY                                         STATE                ZIPCODE


 
 DATE OF BIRTH   MONTH/DAY/YEAR  HOME TELEPHONE
 (___) ______________		  SEX
 F ( )   M ( )		  Chapter Membership with:


 SPOUSES FIRST NAME:
 SPONSORED BY:  
SECTION A - AUTHORIZATION

 
The United States Office of Personnel Management is authorized to make an appropriate deduction from my annuity payments, not to exceed the amount certified by the NATIONAL ASSOCIATION of POSTMASTERS as the amount of dues for which I am obligated, and to pay the deducted sum to the NATIONAL ASSOCIATION  of POSTMASTERS.   This authorization shall also apply to any and all dues changes certified by the NATIONAL ASSOCIATION of POSTMASTERS.

This authorization shall be valid until the NATIONAL ASSOCIATION of POSTMASTERS receives and processes my written notice of cancellation in accordance with its agreement with the United States of Personnel Management.  Any disputes regarding this allotment authorization shall be a matter between the NATIONAL ASSOCIATION of POSTMASTERS and myself and I hold the United States Office of Personnel Management harmless for any erroneous deductions made pursuant to this authorization.

I also authorize the United States Office of Personnel Management to disclose any information necessary to execute this request.
 SIGNATURE OF CIVIL SERVICE ANNUITANT

 		 DATE

 
SECTION B - FOR USE BY EMPLOYEE ORGANIZATION

NAPUS
8 HERBERT STREET
ALEXANDRIA VA  22305-2600
(703) 683-9027

 
I hereby certify that the retired dues of this organization for the above named member are currently established at
$  30.00 per year.  The amount of the monthly dues withholding for this member is $  2.50  .
 
SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL
                                       
 		  
1187-R 3/93 2410161
Please direct any inquires to NAPUS at above address
NATIONAL OFFICE COPY